Read on Twitter
1/
Inspired by the guru @smlungpathguy here's my first tweetorial. What do you guys think of this submandibular salivary gland? But wait for it - I'm in a generous mood, 3 images!
Inspired by the guru @smlungpathguy here's my first tweetorial. What do you guys think of this submandibular salivary gland? But wait for it - I'm in a generous mood, 3 images!
2/
More from the said salivary gland. Fibrosis and inflammation. Non-specific sialadenitis? Next case? But wait, there is more to come!
More from the said salivary gland. Fibrosis and inflammation. Non-specific sialadenitis? Next case? But wait, there is more to come!
3/
Now here's a circumscribed collection of inflammation (above) in dalliance with an artery. And oh, I almost forgot..there are IgG4 positive cells..lots of them.. and I'm feeling lazy..I don't wish to count
Now here's a circumscribed collection of inflammation (above) in dalliance with an artery. And oh, I almost forgot..there are IgG4 positive cells..lots of them.. and I'm feeling lazy..I don't wish to count
4/
I may not count but but that won't stop me from asking you a question. Is this?
I may not count but but that won't stop me from asking you a question. Is this?
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Let's step back-how does one make a diagnosis of IgG4-related disease and more specifically IgG4-related sialadenitis? The criteria are similar, for the most part, regardless of the organ involved. CRITERIA 1 Inflammation (easy!), 2. Storiform fibrosis -think cart wheel
Let's step back-how does one make a diagnosis of IgG4-related disease and more specifically IgG4-related sialadenitis? The criteria are similar, for the most part, regardless of the organ involved. CRITERIA 1 Inflammation (easy!), 2. Storiform fibrosis -think cart wheel
6/
THE most characteristic feature of IgG4-related disease is obliterative phlebitis - see bigger circle. An elastic stain is awfully helpful in uncovering fully obliterated veins
THE most characteristic feature of IgG4-related disease is obliterative phlebitis - see bigger circle. An elastic stain is awfully helpful in uncovering fully obliterated veins
7/ The diagnosis of IgG4-related disease required both histological features (at least 2) AND increased IgG4 positive cells (varies by organ) AND wait for it!) IgG4 to IgG ratio > 40% (don't you love counting!)
8/
BUYER BEWARE! This is not a diagnosis for the faint hearted. And DO NOT make this diagnosis in a clinical vacuum -particularly when working with a biopsy. These 5 pillars will spare you from entry into the doghouse
BUYER BEWARE! This is not a diagnosis for the faint hearted. And DO NOT make this diagnosis in a clinical vacuum -particularly when working with a biopsy. These 5 pillars will spare you from entry into the doghouse
9/
This is where you could go wrong! Segment of colon with an infiltrative mass and TONS and TONS of IgG4 positive cells. Your answer on the next tweet
This is where you could go wrong! Segment of colon with an infiltrative mass and TONS and TONS of IgG4 positive cells. Your answer on the next tweet
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Your diagnosis from 9
Your diagnosis from 9
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SYPHILIS! And NOT IgG4-related disease!!! Infection can attract more IgG4 positive cells than IgG4-related disease. Don't tell me you fell for that trap! But no sweat - you're in very good company
SYPHILIS! And NOT IgG4-related disease!!! Infection can attract more IgG4 positive cells than IgG4-related disease. Don't tell me you fell for that trap! But no sweat - you're in very good company
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And that list of diseases associated with increased number of IgG4 positive cells grows by the day! The number 1 enemy on that list is peritumoral IgG4 positive cells - you undercall a malignancy - and you're in the doghouse!
And that list of diseases associated with increased number of IgG4 positive cells grows by the day! The number 1 enemy on that list is peritumoral IgG4 positive cells - you undercall a malignancy - and you're in the doghouse!
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And that's it! Last word of wisdom (from one who has learnt the hard way), crawl to a diagnosis of IgG4-related, don't run or jog or sprint. Whatever you're initial impression, IgG4-related disease is number 9 on your differential diagnosis!
PS Gosh this was demanding!
And that's it! Last word of wisdom (from one who has learnt the hard way), crawl to a diagnosis of IgG4-related, don't run or jog or sprint. Whatever you're initial impression, IgG4-related disease is number 9 on your differential diagnosis!
PS Gosh this was demanding!
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Ooh I forget - that submandibular salivary gland - classic IgG4-related sialadenitis!
Ooh I forget - that submandibular salivary gland - classic IgG4-related sialadenitis!
